On June 26, 2025, the U.S. Supreme Court held that Medicaid beneficiaries have no recourse under 42 U.S.C. § 1983 (Section 1983) to enforce their right under the Medicaid Act to receive care from any qualified provider of their choice. The decision in Medina v. Planned Parenthood South Atlantic, No. 23-1275, 606 U.S. ___ (2025) resolves a circuit split and has broad implications for private enforcement of federal spending statutes, particularly in the Medicaid context.

Case Background

In July 2018, South Carolina’s governor issued an executive order prohibiting clinics that render abortion services from participating in the state’s Medicaid program, even if they provide other types of covered services in addition to abortions. Planned Parenthood, along with patient Julie Edwards, sued the state, claiming that the exclusion violates the “any-qualified-provider” provision in the Medicaid statute. That provision requires states to ensure that “any individual eligible for medical assistance . . . may obtain” it “from any [provider] qualified to perform the service . . . who undertakes to provide” it. 42 U.S.C. § 1396a(a)(23)(A). The plaintiffs brought a class action under Section 1983, which allows private parties to sue state actors who violate their “rights” under the federal “Constitution and laws.” The state argued that federal statutes, like Medicaid, do not automatically confer enforceable “rights” under Section 1983.

The district court granted summary judgment for the plaintiffs in 2022 and enjoined the South Carolina government from excluding Planned Parenthood from the Medicaid program, finding that the organization was qualified to provide Medicaid services to residents in the state. The Fourth Circuit affirmed the decision of the district court, after which the Supreme Court issued a “GVR” order  (i.e., the Court granted certiorari, vacated, and remanded) in light of its decision in Health and Hospital Corporation of Marion Cty. v. Talevski, 599 U. S. 166 (2023). Talevski addressed whether another spending-power statute created enforceable rights under Section 1983. On remand, the Fourth Circuit reaffirmed its decision, and the issue of whether this provision of the Medicaid Act confers individual rights enforceable under Section 1983 was once again presented to the Supreme Court.

Majority Opinion

In a 6-3 opinion authored by Justice Gorsuch and joined by Justices Roberts, Thomas, Alito, Kavanaugh, and Barrett, the Court held that Medicaid beneficiaries do not have standing to bring a lawsuit challenging the state’s decision to exclude Planned Parenthood from the Medicaid program. The Court held that while 42 U.S.C. §1396a(a)(23)(A) may confer some benefits, it does not clearly and unambiguously confer individual rights enforceable under Section 1983 and, therefore, Medicaid beneficiaries do not have standing to sue.

The Court emphasized the following key points:

  • Stringent Standard for Enforceable Rights: The Court reaffirmed that, “as a matter of course,” federal statutes do not confer rights enforceable under Section 1983. Instead, federal statutes only provide for a private cause of action where they deprive rights, privileges, or immunities, and those rights and privileges must be “clearly and unambiguously” provided for by Congress by using “rights-creating terms” in the granting statute. This is a “demanding” test, rarely satisfied, especially for statutes enacted under Congress’s spending power.
  • Spending-Power Statutes: The Court reiterated that in spending-power statutes, such as the Medicaid Act, the federal government provides funds to states under delineated circumstances. The typical remedy for state noncompliance with those statutes is to withhold federal funds—not seek private enforcement. According to the Court, for a private right of action to exist, Congress must “speak with a clear voice, and manifest[] an unambiguous intent to confer individual rights.”  Only then would the Court consider states to be on notice that acceptance of federal funds subjects them to private suits.
  • Analysis of the “Any-Qualified-Provider” Provision: The Court found that 42 U.S.C. § 1396a(a)(23)(A) lacks the explicit rights-creating terms found in the Federal Nursing Home Reform Act provisions at issue in Talevski, which the Court stated is the only appropriate analogue in this instance. The Medicaid Act addresses state obligations and while it may benefit providers and patients, it does not unambiguously create individual rights.
  • The Court Backed Away from Other Noteworthy Precedents:  Included in the discussion of the majority opinion is a seeming reversal of earlier positions on Section 1983 case law in the Medicaid context, including the case of Wilder v. Virginia Hospital Assn., 496 U.S. 498 (1990), among others. In Wilder, the court “held that health care providers could use [Section] 1983 to enforce a provision of the Medicaid Act that required States to reimburse them at the ‘reasonable and adequate’ rates.” The majority opinion in this case, however, noted that “[t]o the extent lower courts feel obliged, or permitted, to consider the contrary reasoning of Wilder . . . they should resist the impulse.”  This calls into question prior case law that “suggested that spending power legislation can give rise to an enforceable right under [Section] 1983 so long as the legislation is ‘intended to benefit the putative plaintiff’ and the plaintiffs’ interest in the statute is not ‘too vague and amorphous.’” These concepts of intended benefit have woven their way through various aspects of the Medicaid and Medicare programs, and it remains to be seen what ripples this clearer turn of direction will have.

The Court rejected several counterarguments addressed in Justice Jackson’s dissent, discussed further below, including an argument based on legislative history that Congress intended the provision to confer a right, as shown in hearing transcripts and committee reports. But the majority adhered to textualism: “When it comes to interpreting the law, speculation about what Congress may have intended matters far less than what Congress actually enacted,” Justice Gorsuch stated in his opinion. The majority felt that this is especially important in a spending-power statute because states choosing to accept federal funds must clearly be told what to expect.

Although South Carolina’s decision to exclude Planned Parenthood was due to the organization’s provision of abortions, the majority opinion mentions the word “abortion” just twice—to acknowledge two facts: 1) that Planned Parenthood performs abortions, and 2) that South Carolina’s decision to revoke Planned Parenthood’s eligibility from participating in the state Medicaid program was due to a state law prohibiting the use of public funds for abortion. But because the majority determined the Fourth Circuit had erred in analyzing whether Section 1983 allowed for individual plaintiffs to bring suit under this provision, it did not address the merits of the case. That is, it did not address whether South Carolina acted improperly under the law by excluding Planned Parenthood from Medicaid. Nor did the majority address the implications of its opinion, which is that cutting off Medicaid funding to Planned Parenthood clinics in the state will diminish the availability of covered primary care services provided by those and similar clinics.

  • Stringent Standard for Enforceable Rights: The Court reaffirmed that, “as a matter of course,” federal statutes do not confer rights enforceable under Section 1983. Instead, federal statutes only provide for a private cause of action where they deprive rights, privileges, or immunities, and those rights and privileges must be “clearly and unambiguously” provided for by Congress by using “rights-creating terms” in the granting statute. This is a “demanding” test, rarely satisfied, especially for statutes enacted under Congress’s spending power.
  • Spending-Power Statutes: The Court reiterated that in spending-power statutes, such as the Medicaid Act, the federal government provides funds to states under delineated circumstances. The typical remedy for state noncompliance with those statutes is to withhold federal funds—not seek private enforcement. According to the Court, for a private right of action to exist, Congress must “speak with a clear voice, and manifest[] an unambiguous intent to confer individual rights.”  Only then would the Court consider states to be on notice that acceptance of federal funds subjects them to private suits.
  • Analysis of the “Any-Qualified-Provider” Provision: The Court found that 42 U.S.C. § 1396a(a)(23)(A) lacks the explicit rights-creating terms found in the Federal Nursing Home Reform Act provisions at issue in Talevski, which the Court stated is the only appropriate analogue in this instance. The Medicaid Act addresses state obligations and while it may benefit providers and patients, it does not unambiguously create individual rights.
  • The Court Backed Away from Other Noteworthy Precedents:  Included in the discussion of the majority opinion is a seeming reversal of earlier positions on Section 1983 case law in the Medicaid context, including the case of Wilder v. Virginia Hospital Assn., 496 U.S. 498 (1990), among others. In Wilder, the court “held that health care providers could use [Section] 1983 to enforce a provision of the Medicaid Act that required States to reimburse them at the ‘reasonable and adequate’ rates.” The majority opinion in this case, however, noted that “[t]o the extent lower courts feel obliged, or permitted, to consider the contrary reasoning of Wilder . . . they should resist the impulse.”  This calls into question prior case law that “suggested that spending power legislation can give rise to an enforceable right under [Section] 1983 so long as the legislation is ‘intended to benefit the putative plaintiff’ and the plaintiffs’ interest in the statute is not ‘too vague and amorphous.’” These concepts of intended benefit have woven their way through various aspects of the Medicaid and Medicare programs, and it remains to be seen what ripples this clearer turn of direction will have.

Justice Thomas included a concurrence addressing some of the historical aspects of Section 1983.

Dissenting Opinion

In a dissenting opinion, Justice Jackson, joined by Justices Sotomayor and Kagan, stated she would have reached the opposite conclusion of the majority: that the Medicaid Act’s free-choice-of-provider provision readily creates an enforceable right under Section 1983. In doing so, Justice Jackson conducted a review of the 1871 Act, the law that added Section 1983 to the U.S. Code.

Justice Jackson explained that Section 1983’s original intent was to authorize private citizens to sue state or local officials who deprive them of “any rights under the Constitution or the laws” of the United States. She noted that the Court’s prior precedent makes clear that “and laws” is not limited to some subset of laws; rather, it provides protection if the law confers “rights, privileges, or immunities.” She went on to recognize that while the Court has implemented a more stringent test for evaluating the enforceability of statutory rights under Section 1983 more recently, it has also rejected the attempt to dilute Section 1983’s power by affirming that “laws means laws,” in the broadest sense. Thus, Justice Jackson concluded that Medicaid’s free-choice-of-provider provision is “rights-creating,” and should fall within the scope of Section 1983.

Key Takeaways

  • The Ability to Bring Individual Challenges to Enforce Benefits Conferred Under Congressional Spending Powers Is Significantly Limited: The Court’s holding that there is no private right of action for Medicaid beneficiaries under Section 1983 provides insight into how the Court is likely to construe other rights under Congress’s spending power, in particular. This will impact beneficiaries’ ability to choose any willing and qualified provider and gain access to critical health care services.
  • Nationwide Implications for Health Care Services: Although this case impacts funding for Planned Parenthood in South Carolina, it is likely to have nationwide impact, as other states may pursue similar efforts and increase scrutiny of specific providers. States now have more leeway to determine which types of providers may and may not provide Medicaid-covered services. This could open the door to the possibility that states may exclude politically-disfavored providers or providers who offer disfavored types of health care. The restriction of private rights of action under Section 1983 to enforce provisions of the Medicaid Act that do not confer unambiguous rights suggests many of these actions may face less judicial scrutiny in the future.

Reed Smith will continue to follow developments both with regard to Medicaid and in the restriction of reproductive rights. If you have any questions about this decision or its impact, please reach out to the authors.